How is Alzheimer’s treated?

Alzheimer’s disease (AD) is such a complex disease that there is little likelihood of finding one treatment or cure. Scientists are focusing on many aspects of the disease as they seek solutions. Current treatments focus on (1) maximizing cognitive abilities, (2) managing behavioral and psychological symptoms, and (3) slowing, delaying or preventing Alzheimer’s disease.

Maximizing Cognitive Abilities

The U.S. Food and Drug Administration (FDA) has approved four medications to treat Alzheimer’s disease: Donepezil (Aricept*), rivastigmine, (Exelon*), galantamine (Razadyne*), and Memantine (Namenda*). Aricept, Exelon, and Razadyne are acetylcholinesterase inhibitors, which stop the breakdown of acetylcholine, a neurotransmitter or chemical messenger that facilitates communication between cells. Namenda, an NMDA receptor antagonist, regulates the level of another neurotransmitter, glutamate. Excess glutamate in Alzheimer’s disease causes overstimulation (i.e., “excitotoxicity”) and cell death.

Aricept is approved for use at all stages of Alzheimer’s disease, while Exelon and Razadyne are specifically for individuals with mild-to-moderate impairment. Namenda is the only medication approved for moderate-to-severe Alzheimer’s disease. All four medications can enhance cognitive abilities, improve everyday functioning and, in some cases, help alleviate behavioral symptoms. While current medications can improve symptoms of Alzheimer’s disease, these drugs do not change the underlying disease process, which continues.

Managing Behavioral Symptoms

In mild cognitive impairment (MCI) and throughout the course of Alzheimer’s disease, affected individuals can experience a variety of behavioral and psychological symptoms. Common symptoms include apathy, depression, agitation, anxiety, suspiciousness and paranoia, hallucinations, and wandering. Symptoms vary from individual to individual and wax and wane during the disease process. Guiding principles in the treatment of behavioral and psychological symptoms of dementia are:

Rule out unrecognized medical illnesses that could be causing a change in behavior

If there is no medical cause, try behavioral strategies first to manage the symptom

Use medications with caution, as the antipsychotic drugs frequently prescribed for behavioral and psychological symptoms of dementia are not approved for this use, have little benefit, and come with significant side effects, including increased risk for death

Partner with your doctor to address behavioral symptoms and the use of medication, when necessary